It’s easy to think of many of the key target areas for environmental health specialists as pertaining to ‘someone else.’ After all, the United States has clean drinking water, sewage containment, air quality standards and large federal agencies focused specifically on food safety, emergency preparedness and infectious disease. Yet, a second glance underscores how real those problems are here, as well.

National Environmental Health Association Executive Director David T. Dyjack, DrPH, CIH, pointed out concerns at home include transitions in the conditions under which individuals live, the food they eat, drought and other effects of climate change, emerging threats brought into the country, and an aging infrastructure. Adding stress to that infrastructure is a shifting population pattern. America, like most of the rest of the world, is rapidly urbanizing. Dyjack noted 5 percent of local health departments now service 50 percent of the U.S. population.

As needs shift, the field of environmental health is also evolving. While prevention has always been a focus, the need for early intervention has taken on increasing importance.

“In line with the social determinants of health, 80 percent of a person’s health status has little to do with a person’s clinical care … 80 percent is related to where you live and lifestyle choices – what you eat, what you drink, how you recreate,” he said, adding that is the purview of the environmental health specialists that make up NEHA’s membership. “This is why clinicians and environmental health professionals need to work together much more collaboratively.”

Prevention, he said, is a ‘pennies on the dollar’ proposition. However, Dyjack continued, “The irony is over 95 percent of every health dollar spent in this country is spent on clinical care, and less than 5 percent is spent on prevention.” He added, “Public health and environmental health is a best buy for citizens of this country. The investment is inverted.”

One Health

“One of the issues that is not getting the attention it deserves is what is being referred to as ‘One Health,’” Dyjack said. He explained the concept seeks to unify the health of animals and humans.

The initiative looks to forge collaborations “between physicians, osteopathic physicians, veterinarians, dentists, nurses and other scientific-health and environmentally related disciplines,” according to OneHealthInitiative.com.

In addition to emerging zoonotic diseases, the One Health concept recognizes the ease of geographic transmission of illness in modern society. “The world is effectively globalized,” said Dyjack. “The diseases that are incubating in megacities and in the developing world, those diseases can easily be transported in a day.”

He continued, “For the record, what happened this last year with Ebola was entirely predictable, entirely preventable, and environmental health professionals should have played a major role in both the prevention and mitigation of the chaos that ensued.”

Dyjack added that a system should have been put in place after the breakout in the 1970s to thwart future epidemics. However, money wasn’t allocated at that time. “And we paid the price for that lack of investment this year,” he said.

In addition to the very real human toll, the World Health Organization estimates $32 billion has been spent in the aftermath of the recent Ebola crisis. Dyjack pointed out building health systems in West Africa would have been a fraction of the cost.

“It is in our own interest to ensure rudimentary health systems are in place where organisms like Ebola are likely to be present. Hygiene, sanitation, water systems, the use of personal protective gear … this is the domain of environmental health.”

U.S. Water Supply

A safe water supply isn’t only a challenge for less developed nations, however. Dyjack said it is a very real issue for Americans, as well.

“On average each year in this country, we lose about one trillion gallons of fresh water,” he said, adding the loss comes from cracks in a crumbling and aging infrastructure.

That loss impacts both economies and the health of populations. The combination of water management processes and prolonged drought has had a dire effect on a number of agricultural counties in California. In addition, Dyjack said, valley fever has become a growing problem in the area as the desiccation of the land allows wind to blow around organisms in the topsoil and spread fungi into the air.

Other water-borne issues include the spread of Legionella (which can lead to Legionnaires’ disease and Pontiac fever), a bacteria that has been showing up in commercial buildings in the ventilation systems and can be inhaled through water aerosols. In the Great Lakes area, an algae bloom producing the toxin microcystin is contaminating the water supply, posing a challenge for traditional water treatment systems. In the Pacific Northwest, the algae has also led to economic damage as crab and clam harvests have had to be closed down at times.

Leading NEHA Efforts

Passionate about his profession, Dyjack took the helm of the NEHA in May of this year. He has almost 30 years experience in environmental health, emergency preparedness and response, public health informatics, infectious disease, workforce development, governmental infrastructure, maternal and child health, health equity, and chronic disease. A board certified industrial hygienist, Dyjack also has advanced degrees in public health with a doctorate from the University of Michigan and a master’s degree from the University of Utah. Previously he served as associate executive director for programs with the National Association of County and City Health Officials and also has 18 years of academic experience in public health at Loma Linda University.

“I believe environmental health is central to health and wellness of individuals, to families … and frankly, to economies of cities, counties and states,” Dyjack said.

When we have resisted moves to intervene early, he noted, the cost has often been much heavier on the back end. “We just have to have the courage to redirect resources from the clinical environment to a prevention strategy,” Dyjack concluded.

RELATED LINKS:

CDC National Center for Environmental Health: http://www.cdc.gov/nceh/

One Health Initiative: www.OneHealthInitiative.com